Uniwarfin

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What Is Uniwarfin?

Uniwarfin is 5 mg warfarin sodium tablets from Unichem, supplied in 30-90 tablets. Warfarin is the most widely used oral anticoagulant in the world. Despite the introduction of direct oral anticoagulants (DOACs), warfarin remains the first-line choice in mechanical heart valves, rheumatic mitral stenosis, antiphospholipid syndrome, and selected high-risk patients where DOAC evidence is weak.

How Warfarin Works

Warfarin inhibits vitamin K epoxide reductase (VKORC1) in hepatocytes, blocking the recycling of vitamin K. This depletes the active γ-carboxylated forms of factors II, VII, IX and X plus the natural anticoagulants protein C and S. Anticoagulant effect is delayed 3-5 days as existing circulating factors are catabolised — bridging with parenteral heparin or LMWH is needed when rapid anticoagulation is required.

Godkjente Bruksområder

• Mechanical heart valves — warfarin is the only acceptable oral option (DOACs are contraindicated; RE-ALIGN trial)
• Moderate-to-severe (rheumatic) mitral stenosis — with or without atrial fibrillation
• Antiphospholipid syndrome (triple-positive) — warfarin INR 2-3 outperformed rivaroxaban (TRAPS, 2018)
• Atrieflimmer — where DOACs are contraindicated, intolerant, or unaffordable; established stroke prevention
• Venous thromboembolism (DVT and PE) — treatment and extended secondary prevention
• Left-ventricular thrombus, post-MI mural thrombus, dilated cardiomyopathy with thrombus

Dosage and INR Targets

Warfarin dose is highly individualised and titrated to the international normalised ratio (INR). Typical maintenance is 2-10 mg daily but ranges from <1 mg to >15 mg.

INR is checked daily during initiation, then weekly until stable, then every 4-12 weeks long-term. Time-in-therapeutic-range (TTR) above 65-70% is the quality benchmark.

Pharmacogenomics: VKORC1 and CYP2C9

Patients carrying VKORC1 -1639 G>A (sensitive) or CYP2C9 *2 / *3 (slow metaboliser) require lower starting and maintenance doses. Genotype-guided dosing reduces time to stable INR but is not routine in most centres.

Diet, Alcohol, and Lifestyle

Bivirkninger

• Bleeding (epistaxis, gum bleeding, bruising, GI bleeding, intracranial haemorrhage)
• Skin necrosis — rare; days 3-8 of initiation, especially in protein C deficiency; bridge with heparin to mitigate
• Purple toe syndrome (cholesterol microemboli) — rare
• Hair loss, rash
• Hepatic enzyme elevation

Kontraindikasjoner

• Active major bleeding (peptic ulcer, intracranial haemorrhage)
• Pregnancy — teratogenic in first trimester (warfarin embryopathy), CNS bleeding risk later. Use LMWH instead
• Severe uncontrolled hypertension
• Alvorlig leversvikt
• Recent neurosurgery, ophthalmic surgery, or major trauma with bleeding risk
• Inability to comply with INR monitoring

Drug Interactions (selected)

Warfarin has hundreds of clinically relevant interactions. Always check before starting, stopping, or changing the dose of any drug.

• Raise INR: amiodarone, fluconazole/voriconazole/itraconazole, metronidazole, trimethoprim-sulfamethoxazole, ciprofloxacin, macrolides (clarithromycin, erythromycin), high-dose paracetamol, omeprazole, fluvastatin, cranberry, grapefruit, fish oil, NSAIDs (also bleeding-risk additive).
• Lower INR: rifampicin, carbamazepine, phenytoin, phenobarbital, St John’s wort, vitamin K (multivitamins, enteral feeds), large amounts of leafy greens.
• Additive bleeding risk: aspirin, clopidogrel, NSAIDs, SSRIs/SNRIs, heparins.

Reversal of Anticoagulation

Surgery and Dental Procedures

For most surgery, stop warfarin 5 days before. Bridge with LMWH only if high thromboembolic risk (mechanical mitral valve, recent VTE <3 months, CHA2DS2-VASc ≥6). Most simple dental procedures can be done at therapeutic INR without stopping warfarin. Resume the night of surgery if haemostasis is secured.

Pregnancy and Breastfeeding

Pregnancy: warfarin is teratogenic in the first trimester (warfarin embryopathy: nasal hypoplasia, stippled epiphyses) and crosses the placenta with foetal CNS bleeding risk later. LMWH is preferred throughout pregnancy except in mechanical heart valve patients where individualised specialist plans apply. Breastfeeding: warfarin does not transfer into breast milk in clinically relevant amounts — safe.

Oppbevaring

Store Uniwarfin below 25°C in the original blister pack, protected from light. Keep out of reach of children — warfarin overdose is the most common acute paediatric anticoagulant poisoning.

Vanlige spørsmål

Why does Uniwarfin take days to work?

Warfarin blocks the production of new clotting factors but does not inactivate circulating ones. The clinical effect builds over 3-5 days as existing factors are catabolised. When immediate anticoagulation is needed, parenteral heparin or LMWH is bridged until the INR is therapeutic.

Why do I need INR tests so often at the start?

Dose response varies enormously between people because of CYP2C9 and VKORC1 genetics. INR is checked daily until in range, then weekly, then every 4-12 weeks long-term once stable.

Can I eat green vegetables on Uniwarfin?

Yes — the rule is consistency, not avoidance. Eat your usual amount day-to-day. Sudden large changes (a salad-heavy week, then none for a fortnight) are what destabilises INR.

What should I do if my INR is too high?

Hold the next dose, contact your anticoagulation clinic, and watch for bleeding. INR >10 or any active bleeding is a same-day emergency — oral or IV vitamin K and possibly 4-factor PCC.

Can I take Uniwarfin with paracetamol?

Occasional paracetamol is fine. Regular use of paracetamol >2 g/day for several days raises INR and should prompt INR monitoring.

What about ibuprofen or other NSAIDs?

Avoid — NSAIDs both raise INR and add an independent platelet-inhibiting bleeding risk. If pain relief is needed long-term, paracetamol is preferred and PPI cover should be considered.

Why can’t I switch to a DOAC?

You can in many indications. DOACs (apixaban, rivaroxaban, dabigatran) are now first-line in non-valvular AF and VTE. Warfarin remains the only acceptable oral choice for mechanical heart valves, rheumatic mitral stenosis, and triple-positive antiphospholipid syndrome — DOACs are contraindicated or inferior in these.

Can I drink alcohol on Uniwarfin?

Moderate consistent alcohol (1-2 drinks/day) is acceptable. Binge drinking destabilises INR and raises bleeding and fall risk; abstinence or very moderate intake is safer.

Hva hvis jeg trenger operasjon?

Stop warfarin 5 days before; bridging with LMWH is reserved for high-thromboembolic-risk patients (mechanical mitral valve, recent VTE). Most simple dental work does not need warfarin to be stopped.

Where can I buy Uniwarfin online?

You can buy Uniwarfin (5 mg warfarin sodium, 30-90 tablets) from MedsBase with discreet packaging and worldwide shipping.

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